Santénet2 in Madagascar: A Personal Account

You Heard Us and Came: A Personal Look at How RTI Is Improving Health Care in Madagascar — Part 2

The following feature article is a personal account by Volkan Cakir, Santénet2 chief of party for RTI. Cakir and a Santénet2 colleague spent three days hiking through the Madagascar mountains to experience what a typical Malagasy goes through to receive access to health care. This is the second of three articles about the journey. You can read the first article here.

A sign touting the benefits of health care in Madagascar

Over the course of this journey, we had discussions with all the community health workers (CHWs) we met about the services they provide, their perceptions of community members, challenges they face, and their suggestions for improvements.

All community members were also very pleased with the presence of CHWs. Women were pleased to have convenient access to basic health services for themselves and their children. Similarly, CHWs proudly presented their clients to us, particularly women who choose to use family planning services.

On the second day, we continued hiking and climbed the first mountain. After four hours, we reached Ampokafo and met with Charletine and Paul, the village's CHWs. Paul, a child health CHW, came to meet us on our way to the village. We had lunch in a greasy-spoon restaurant and went to visit Charletine's hut. We discussed their achievements and challenges as CHWs.

Wading through a stream between villages

Our next stop was Ambohimarina, where Meline (a mother health CHW) met us on our way to the village. Sylvianette had a four-month-old baby and was breastfeeding, setting a good example for other mothers in her community. Both Meline and Sylviannette, like all other CHWs, had service and management tools produced and disseminated by the project, including a family planning compliance poster, a rapid diagnostic test job aid, a child nutrition job aid, the Ezaka Mendrika quarterly bulletin, an antenatal care package poster, monthly reports, baby scales, buckets, soap, timer, and a sharps box to dispose of used syringes and rapid diagnostic tests. They also had all the drugs and contraceptives necessary to provide services.

We continued our journey another two hours, climbing a second major mountain and walking on the northwest side of the Masoala nature reserve, one of the most beautiful and well preserved conservation areas of Madagascar. Despite recent rosewood pillaging and lemur poaching, the park preserves its spectacular scenery, dense vegetation, lush hills, steep trails, and the sounds of chanting lemurs.

Downhill walking necessitated particular attention because of the trail's steepness and roots growing across the path. This strenuous day—10 hours of hiking under rain and through muddy and rocky terrain—ended on a high note as we met with community leaders. They too expressed their pleasure at our visit and insisted on presenting us to the entire community the next morning before our departure. Almost all of the community leaders, women and men, have great enthusiasm, fueled by the pride of doing good work in their communities.

Volkan Cakir posing with Santénet workers

The majority of people in the villages we passed through are farmers. The average farm in Madagascar is very small (0.5 hectares). These undersized plots require an enormous effort to work the land, and unfortunately they do not produce enough food to feed the families that work them. In the northeast regions, peasants also produce cash crops (vanilla, coffee, cloves) along with the traditional rice and yams. The undersized farms and low productivity limit the income generated by farmers. People usually eat meat twice a year, during Easter and on Independence Day. The rest of the year, they eat yams, rice, and local leaves that have very limited nutritional value.

In addition, none of these villages have electricity, and the majority of the population uses surface water from the river to wash, cook, and drink. More prosperous villagers use water purification solutions, but this is not accessible to the poor. Public services are limited to schools and churches. On the 80-km trail, there were two primary health care clinics (Centre de Santé de Base), one of which was closed due to a staff shortage.